I am your patient today! Part 1 of 2: Taking clinical education online
In Part 1 of this 2-part post, Professor Raj Ariyaratnam, Chair in Dental Education and Global Oral Health, and Dr Eleni Deligianni, Clinical Lecturer in Oral Medicine, from the Division of Dentistry, School of Medical Sciences, share how “I am your patient today” – an online, synchronous, clinical teaching programme which began as a strategy to continue the provision of essential clinical learning experience for students during lockdown – is being taken forward within a blended environment.
Raj and Eleni presented this work at the ADEE (Association of Dental European Education) annual conference 2021.
The teaching of Oral Medicine in the University of Manchester expands over the final three years of the 5-year BDS Dentistry programme. At year 4, the students will see suitable pre-triaged patients in clinical settings and take a full history and examination before presenting the cases to the tutor to discuss possible diagnosis, differential diagnosis, and management. So the clinic-centred study sessions are the vital part of their learning experience.
Though online teaching and distant learning has been in practice for many years, during the COVID-19 lockdown restrictions it was very challenging for clinical disciplines like Dentistry and Medicine to replace clinic-based teaching and learning experiences. In an effort to maintain an uninterrupted high-quality teaching and learning experience we innovated the “zoom clinic” – ‘I am your patient today’, a synchronous clinical teaching model using the zoom platform.
The main objectives remained the same as for ‘real life’ clinical teaching: i) the understanding of clinical features, diagnosis and holistic management of Oral Disease, ii) history taking skills, iii) examination and recording skills, iv) communication, team working, leadership, self- and group- assessment skills. Using real GDP/GMP referral letters, especially selected against set learning objectives, we developed patient focused clinical scenarios which were presented to the students on the zoom by the tutor. The tutor became the patient for each scenario and, drawing from experience, would enact the patient in a role-play guided session, trying to make the experience as realistic as possible (Part 2 of this post will explore the use of drama in medical education). Clinical examination was replaced by clinical photos provided for each case and again shared digitally. Each session exactly simulated the ‘in-clinic’ teaching and learning environment.
Only 4-5 students were timetabled for each session, as in the normal clinical programme. Each cohort of students was following the programme for one day per week over 5 weeks. After each stage of learning the tutor and students would discuss their performance and co-create a holistic management plan to complete the case study. During and at the end of each session team working, self-assessment, peer assessments and tutor feedback were encouraged on Zoom. Programmes were recorded for future asynchronous reference. Once the lockdown lifted, we seamlessly transferred the zoom clinics to real F2F clinics, and we plan to continue to use this as an additional synchronous teaching and learning tool.
The students’ feedback and summative exam results confirmed the qualitative and quantitative impacts and values, and ‘I am your patient today’ won the Faculty of Biology, Medicine and Health (FBMH) Pandemic Pedagogy Teaching Award.
All students found that the learning objectives were met, and that this way of teaching was more enjoyable and kept their attention on the subject for longer compared to a traditional teaching seminar, thus enhancing their knowledge and clinical skills. One student commented favourably for this way of teaching but as an additional feature to actual clinical time.
Some other student comments:
“This course was brilliant, and I think it should be incorporated into the curriculum to complement the OMED sessions we have in the third year. I thoroughly enjoyed the sessions. Would have loved them to carry on beyond the 4 weeks.”
“The sessions were enjoyable and a great substitution to actual clinical exposure which is currently restricted to COVID-19.”
“This was one of the best bits of learning we have had this year. The format worked really well on zoom. If anything, it is sad that we only have 4 sessions of this (it would be great to have a much longer course!)”
“Thought the way it was delivered was brilliant, I really enjoyed the role-playing patient aspect as it made the sessions informal and stimulated questions. I felt confident to speak and ask ‘silly’ questions to help better my understanding of oral medicine. Our tutor was great for the sessions as the cases shown and the explanation of differential diagnosis was, I felt pitched at an appropriate level which didn’t overwhelm me and helped focus in on the case.”
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